Acceptability and satisfaction of self-collection for chlamydia and gonorrhoea testing among transgender women in the Tangerine Clinic, Thailand: shifting toward the new normal

BACKGROUND: Provider-collected swabs are an unappealing procedure for many transgender women due and may have led to suboptimal rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) testing. Self-collection for CT and NG testing is recommended for men who have sex with men and cisgender women, but the information is lacking for transgender women. We aimed to determine the acceptability and satisfaction of self-collection for Thai transgender women.
METHODS: Thai transgender women who attended the Tangerine Clinic'a transgender-led, integrated, gender-affirming care and sexual health service in Bangkok'between May and July 2020 and had condomless sexual intercourse within the past six months were offered to collect urine and perform self-swabs of pharyngeal, rectal, and if applicable, neovaginal compartments for pooled nucleic acid amplification testing for CT and NG (Abbott Real Time CT/NG, Abbott Molecular Inc., Illinois, USA). Participants were given a diagram of self-collection instructions. Self-administered questionnaires were used to assess satisfaction. The prevalence of CT and NG infections among those who accepted self-collection was compared to our historical cohort consisting of 764 transgender women who underwent provider-collected samples between 2015 and 2017.
RESULTS: A total of 224 transgender women were offered self-collection, and 143 (63.8%) accepted. All had pharyngeal, rectal, and urethral samples collected. Of 28 who had undergone gender-affirmative surgery, all accepted neovaginal self-swab. Acceptance increased from 43.9% in May to 82.7% in July 2020. All transgender women who accepted self-collection were able to perform it without assistance, and 82.8% were highly satisfied with the method. None reported dissatisfaction. No invalid results were reported from these samples. The pooled prevalence of CT and NG infections among transgender women performing self-collection was 23.1% and 17.5%, respectively; comparable to our historical cohort (22.9% CT infection, 14.3% NG infection).
CONCLUSIONS: Thai transgender women had high acceptability and satisfaction of self-collection for CT and NG testing. Our results support the implementation of self-collection services to maintain and/or increase sexually transmitted infection testing uptake, particularly during the COVID-19 pandemic where physical distancing is the new normal. A larger study is warranted to determine and confirm the CT and NG test performance between self-collection and provider-collection.